Expect Questions from Patients

Like all early detection strategies, screening mammography involves trade-offs,” H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, of the Dartmouth Institute for Health Policy & Clinical Practice, Hanover, New Hampshire, wrote in a Special Communication in JAMA Internal Medicine.1 They attempted to reduce the uncertainty surrounding these issues by providing a range of estimates on three outcomes that can have an impact on whether a woman chooses to have screening mammography. For the midrange age group (50-year-old women), the estimated ranges are that out of 1,000 women, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least one false alarm (requiring recall testing, including biopsies), and 3 to 14 will be overdiagnosed and receive treatment.

While these estimates are intended to make women feel more comfortable about their decision to pursue or not pursue mammography, the authors acknowledge that “for many women these ranges may not be sufficiently precise to make an informed choice.”

Analogies to Prostate Cancer Screening

Individual patients may or may not have strong opinions about the value of screening. Dr. Welch, whose clinical work is with men at the Department of Veterans Affairs, told The ASCO Post that he views screening for prostate cancer and breast cancer as analogous issues. “Some men are full-on ready to be screened. Others don’t want to be screened: ‘Doc, if it ain’t broke, don’t fix it.’ And then there is the in-between group who want to consider this more carefully, want to understand what the debate is about,” he said.

“The same is probably true of women, and I think it is a close enough call that if women come in with a very strong prior opinion about wanting or not wanting to be screened, those are women we shouldn’t try to dissuade either way. But there may be a middle group who really want to consider this, and if they do, I think that consideration should be informed by some data. We tried to provide that.”

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“If women are to truly participate in the decision of whether or not to be screened [for breast cancer using mammography], they need some quantification of its benefits and harms,” asserted H. Gilbert Welch, MD, MPH, Professor of Medicine, and Honor J. Passow, PhD, Instructor, at The Dartmouth...